201224220Have Guidelines Affected Ear, Nose, and Throat Specialists’ Diagnoses and the Prescription of Antibiotics for Acute Otitis Media?22Introduction:
The Ministry of Health and Medical Education of Iran, and similar institutions in many other countries, advises physicians to use current guidelines for the diagnosis and treatment of acute otitis media (AOM). However, there has been no evaluation of the effectiveness of such guidelines or whether physicians in Iran adhere to them. Thus, as laryngologists are the most important group of people who interact with patients with AOM, the aim of this study was to evaluate the attitude of laryngologists to the established guidelines.
Materials and Methods:
A total of 120 anonymous surveys were mailed to 120 otolaryngologists in Tehran, Iran, to evaluate the patterns of diagnosis and treatment of AOM used by these physicians. The survey included questions regarding the otolaryngologists’ age, gender, place of work, and attitude towards diagnosis and treatment of AOM.
Results:
Sixty-two completed surveys were received, for a response rate of 51%. There was no significant difference between respondents to these surveys according to sex, age, practice setting, graduation year, or the number of patients with AOM seen each month.
Conclusion:
Our study adds new insights to the previous literature on the use of guidelines in the management of AOM. We can now assess the impact of guidelines on the usual practice of physicians in evidenced-based management of AOM.1-5562Acute otitis mediaAttitudeKnowledgeOtolaryngologistA Comparative Study of Two Different Uncinectomy Techniques: Swing-Door and Classical22Introduction:
The aim of this study was to determine which technique of uncinectomy, classical or swing door technique.
Materials and Methods:
Four hundred eighty Cases of sinusitis were selected and operated for Functional Endoscopic Sinus Surgery (FESS). Out of these, in 240 uncinectomies classical uncinectomy was done whereas in another 240 uncinectomies swing door technique was used. Initially patients were medically managed treated according to their symptoms and prior management. Patients who had received previous adequate medical management were evaluated with CT scan of the sinuses. If disease still persists than they were operated for FESS.
Results:
The authors' experience indicates that Functional endoscopic sinus surgery can be performed under local or general anesthesia, as permitted or tolerated. In this review classical technique was used in 240 uncinectomies. Out of this, ethmoidal complex injury was noted in 4 cases, missed maxillary ostium syndrome (incomplete removal) was reported in 12 patients and orbital fat exposure was encountered in 5 patients. As compared to 240 uncinectomies done with swing door technique, incomplete removal was evident in 2 cases and lacrimal duct injury was reported in 3 cases. 'Evidence that underscores how this 'swing door technique' successfully combines 'the conservation goals of the anterior-to-posterior approach and anatomic virtues of the posterior-to-anterior approach to ethmoidectomy of the total 480 uncinectomies operated. Out of which 240 uncinectomies have been performed using the 'swing-door' technique. The 240 uncinectomies performed using classical technique were used as controls. The incidence of orbital penetration, incomplete removal, ethmoidal complex injury and ostium non-identification was significantly less with the new technique. Three lacrimal injuries occurred with the 'swing-door' technique compared to no injuries with classical technique.
Conclusion:
The authors recommend swing door technique as it is easy to learn, allows complete removal of the uncinate flush with the lateral nasal wall and allows easy identification of the natural ostium of the maxillary sinus without injuring the ethmoidal complex1-6367--Ankit ASinghaniaDepartment of otorhinolaryngology, SBKS Medical College, Sumandeep University, Waghodia, Vadodara, Gujarat, India.Department of otorhinolaryngology, SBKS MedicalIran--ChetanBansalDepartment of otorhinolaryngology, SBKS Medical College, Sumandeep University, Waghodia, Vadodara, Gujarat, India.Department of otorhinolaryngology, SBKS MedicalIran--NiraliChauhanDepartment of otorhinolaryngology, SBKS Medical College, Sumandeep University, Waghodia, Vadodara, Gujarat, India.Department of otorhinolaryngology, SBKS MedicalIran--SauravSoniDepartment of otorhinolaryngology, SBKS Medical College, Sumandeep University, Waghodia, Vadodara, Gujarat, India.Department of otorhinolaryngology, SBKS MedicalIranClassicalEndoscopic surgeryFunctionalSinusSwing-door techniqueUncinectomyEvaluation of Children with Chronic Rhinosinusitis after Adenotonsillectomy22Introduction:
Chronic rhinosinusitis (CRS), defined as an inflammatory process involving the paranasal sinuses that continues for at least three months, is a major cause of morbidity in the pediatric population and a difficult entity to treat with a poorly defined pathophysiology. The cornerstone of treatment for children with CRS remains aggressive antibiotic therapy, but many patients fail to improve even after extended courses of broad-spectrum oral antibiotics. However, good treatment results with adenoidectomy alone have been reported in pediatric patients with CRS. The purpose of this study was to evaluate the effect of adenotonsillectomy on chronic rhinosinusitis in children.
Materials and Methods:
In this clinical trial the study population was 40 children under 14 years old who had been selected for adenotonsillectomy. Prior to the procedure, a Waters’ view radiograph was performed on individuals that suffered from CRS and displayed symptoms such as rhinorrhea, halitosis, and chronic cough. Only patients with bilateral clouding of the maxillary sinuses were enrolled in study. A further radiograph was performed on the 28th day following the procedure and the outcome of the treatment evaluated.
Results:
Of the 40 patients under 14 years old who were evaluated, 22 (55%) were female and 18 (45%) were male. The mean age of the patients was 7.22 years while the oldest was 14 and the youngest was 4 years old. Nasal congestion, rhinorrhea, post nasal drip, and chronic cough were present in all of the patients. Following the adenotonsillectomy, these symptoms were significantly reduced and were present in only 15.5%, 0%, 20%, and 20% of the patients, respectively. Multivariate analyses were performed using McNemar’s test.
Conclusion:
According to the results of this study, where 72.5% of patients showed a complete recovery following treatment, an adenotonsillectomy can be considered as a treatment modality for CRS.1-6974--FatholahBehnoudAssociate Professor Hamedan university of medical sciences ENT department Besat HospitalAssociate Professor Hamedan university ofIranAdenoidAdenoidectomyPalatine tonsilTonsillectomyThe Epidemiological and Clinical Aspects of Nasal Polyps that Require Surgery22Introduction:
The objective of this retrospective cross-sectional study was to obtain epidemiological data from the charts of 297 patients with nasal polyposis who were operated on in a referral hospital in Mashhad and to determine the frequency of the presenting symptoms of nasal polyps.
Materials and Methods:
The variables recorded included age, gender, the presence of asthma or allergic rhinitis, family history, and previous treatments. We studied the main symptoms of nasal polyposis (nasal obstruction, rhinorrhea, anosmia, headache, epistaxis, snoring, and so on), as well as ear problems and facial deformity.
Results:
Nasal polyposis affects men (60.3%) more frequently, at a mean age of 39.5 years. The most frequent symptom was nasal blockage (81.1 %) followed by rhinorrhea (37.7%). A total of 11.1% of the patients had a history of epistaxis. Asthma was found in 10.4% of patients with nasal polyposis and the ears were affected in 5.1% of patients. In all, 7.4% of patients had first-degree relatives who suffered from asthma or allergic rhinitis.
Conclusion:
This study highlights the need for large-scale epidemiologic research exploring the prevalence and incidence of nasal polyposis in Iran.1-7578--AhmadMeymane JahromiAssistant Professor of Otolaryngology. Department of Otorhinolaryngology, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Assistant Professor of Otolaryngology. DepartmentIran--AyehShahabi PourOtolaryngology Resident. Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Otolaryngology Resident. Faculty of Medicine,IranClinical FeaturesEpidemiologyNasal polyposisProphylactic Antibiotics in Otolaryngologic Surgeries:
From Knowledge to Practice22Introduction:
The management and use of antimicrobial drugs has clinical, economic, and environmental implications. In many countries, antimicrobial drugs are the most frequently prescribed therapeutic agents. Therefore, health-care policy should focus on how to establish a rational attitude toward antibiotics. This study was performed to investigate antibiotic usage as a prophylactic regimen in head and neck surgeries.
Materials and Methods:
This study was a retrospective case series. Patients undergoing otolaryngology surgeries in a tertiary referral otolaryngology center were included. Members of operating room staff that were unaware of the study objectives collected patients’ data using a questionnaire that contained information regarding general medical condition, disease, surgical procedure, and prophylaxis regimen and duration.
Results:
Excluding infected patients, we studied 1349 patients during a four-month period who needed prophylactic antibiotics. A total of 34 different types of surgical procedures were performed. Out of the total number of patients, 503 (37.0%) received a parenteral antibiotic directly before surgery. The main antibiotics used before surgery were cephalosporins (94.9%). All of the 1349 patients were administered antibiotics after the procedure. These antibiotics where given with a mean number of doses of 4.81 (range: 1–68), and also consisted of mostly cephalosporins.
Conclusion:
Our results indicate that prophylactic antibiotics were being significantly misused in a tertiary referral center of a university hospital. Although teaching the principles of prophylaxis to physicians is important, we think that finding a way to bring this knowledge to practice is more important.1-7984--MinooKhatami-MoghadamOtorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir-Alam University HospitalOtorhinolaryngology Research Center, TehranIran--Mohammad-TaghiKhorsandi-AshtianiOtorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir-Alam University HospitalOtorhinolaryngology Research Center, TehranIran--Mohammad-AliMohagheghiCancer Institute, Cancer Research Center, Tehran University of Medical SciencesCancer Institute, Cancer Research Center,Iran--MehrdadHasibi3Department of Infectious Diseases Tehran University of Medical Sciences, Tehran, Iran3Department of Infectious Diseases TehranIran--AliKouhiOtorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir-Alam University HospitalOtorhinolaryngology Research Center, TehranIrana-kouhi@tums.ac.irIncidence of Etiologic Factors in Squamous Cell Carcinoma of Head and Neck in Ahvaz22Introduction:
Squamous cell carcinoma (SCC) is the most common head and neck malignancy. Smoking, alcohol consumption, viral infections, exposure, oral hygiene, and dietary, genetic, and occupational factors are the most important etiologic factors. The aim of this study was determining the incidence of etiologic factors in head and neck SCC.
Materials and Methods:
This is a cross-sectional survey study for the determination of the etiologic factors of head and neck squamous cell carcinoma over a five-year period in the Otolaryngology Department of the Imam Khomeini & Golestan hospitals in Ahwaz.
Results:
176 patients, comprising 151(85.8%) men and 25(14.2%) women, were studied. Overall mean age was 67.2 years. 148 (84.1%) patients were smokers. prolong exposure to chemical fertilizer in 101 (57.4%) patients, Sun exposure in 21 (11.9%) patients, Low socioeconomic status in 124 (70.5%) patients, poor oral hygiene in 128 (72.7%) patients, high intake of hot tea drinking in 84 (47.7%) patients and malignancies in family in 12 (6.8%) patients were the most frequent risk factors. 17 (9.6%) patients have had opioid addiction and HPV was positive in 7 (3.9%) patients by PCR.
Conclusion:
According to this study, tobacco smoking was the most important etiologic factor and had a strong effect on risk of head and neck squamous cell carcinoma. Other factors are also important and need more research study.1-8590--SoheilaNikakhlaghAssociated Prof. of Otorhinolaryngology of imam Khomeini hospitalAssociated Prof. of Otorhinolaryngology ofIrannikakhlagh.s@gmail.com--NaderSakiAssociated Prof. of Otorhinolaryngology of imam Khomeini hospitalAssociated Prof. of Otorhinolaryngology ofIranahvaz.ent@gmail.com--MahmoodHekmat shoarResident of Otorhinolaryngology of imam Khomeini hospitalResident of Otorhinolaryngology of imam KhomeiniIran--AminSartipiporGeneral Physician of Ahvaz health careGeneral Physician of Ahvaz health careIran--SaraSakiMedical Student of shiraz universityMedical Student of shiraz universityIranEtiologic factorsHeadNeckSmokingSquamous cell carcinomaForeign Bodies: Aspirated or Ingested? A Report of Two
Unusual Cases22Introduction:
The diagnosis of foreign bodies in the upper aerodigestive tract is usually straightforward but sometimes it can be delayed or the location of esophageal and upper airway foreign bodies can be mistakenly interchanged.
Case Report:
We present two interesting cases that caused diagnostic challenges which could have led to serious complications if a greater delay in diagnosis had occurred.
Conclusion:
In order to diagnose upper aerodigestive tract foreign bodies without delay, a careful history and physical examination with proper X-rays are helpful.1-9194--AliasgharArabi MianroodiDepartment of Otolaryngology, Head and Neck Surgery, Shafa Hospital, Kerman, IranDepartment of Otolaryngology, Head and NeckIranmrarabi@yahoo.com--YeganehTeimouriDepartment of Otolaryngology, Head and Neck Surgery, Shafa Hospital, Kerman, IranDepartment of Otolaryngology, Head and NeckIran--NeilA.VallanceDepartment of Otolaryngology, Head and Neck Surgery, Monash Medical Center, Melbourne, AustraliaDepartment of Otolaryngology, Head and NeckIranAspirationBronchusEsophagusForeign bodyA Schwannoma of the Soft Palate in a Child: Histological and Immunohistochemical Features and Surgical Method22Introduction:
Schwannoma, or neurilemmoma, is a benign neoplasm of Schwann cells that is extremely rare in the soft palate. Herein we present a case of a soft palate schwannoma presenting with an ulcerated surface and purplish colour in a 12 year-old girl. This report also introduces a successful surgical technique for coverage of the defect left by surgery.1-9599--AminRahpeymaAssistant Professor of oral and maxillofacial surgery, Oral and Maxillofacial Diseases Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.Assistant Professor of oral and maxillofacialIranrahpeymaa@mums.ac.ir--Amir HoseinJafarianAssistant Professor of pathology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.Assistant Professor of pathology, Ghaem Hospital,Iran--SaeedehKhajehahmadiAssistant Professor of oral and maxillofacial pathology, Dental Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.Assistant Professor of oral and maxillofacialIran--JavadSarabadaniAssistant Professor of Oral and Maxillofacial Diseases, Oral and Maxillofacial Disease Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, IranAssistant Professor of Oral and MaxillofacialIranimmunohistochemistrySchwannomaSoft palateSurgical procedures